OB 101 - OB Final Exam Study Guide./Guaranteed A+Guide

Postpartum • The postpartum or the puerperium period is the period of time following the delivery of the child during which the body tissues, especially the reproductive system reverts back to the pre-pregnant state, both anatomically and physiologically. • The puerperium or the postpartum period lasts for 6 weeks. o 1) Immediate Postpartum: the 24-hour period immediately following delivery. o 2) Early Postpartum or puerperium: up to 7 days. o 3) Remote postpartum or puerperium: up to 6 weeks. Reproductive system • Involution of the uterus: rapid reduction in size of the uterus to a nonpregnant state following birth. • Following delivery of the placenta the uterus contracts into a hard mass; the size of a grapefruit • Exfoliation is a very important aspect of involution; if healing of the placenta site leaves a fibrous scar, the area available for future implantation is limited, as is the number of possible pregnancies. • With the dramatic decrease in the levels of circulating estrogen and progesterone following placental separation, the uterine cells atrophy, and the hyperplasia of pregnancy begins to reverse. • Factors that enhance involution include: o an uncomplicated labor and birth o complete expulsion of the placenta or membranes o breastfeeding o manual removal of the placenta during a cesarean birthFactors that slow uterine involution include: o Prolonged labor o Anesthesia o Difficult birth o Grand multiparity o Full bladder o Incomplete expulsion of the placenta or membranes o Infection o Over distension of the uterus (Overstretching of uterine muscles with conditions such as multiple gestation, hydramnios, or a very large baby may set the stage for slower uterine involution.)Uterus • At delivery fundus is at the umbilicus • 1-2 hours: midway between umbilicus and symphysis pubis • 12 hours: 1 cm above or at umbilicus • After that the height of the uterine fundus decreases (involutes) by approximately 1 cm per day. • Within 6 to 12 hours after birth, the fundus of the uterus rises to the level of the umbilicus because of blood and clots that remain within the uterus and changes in support of the uterus by the ligaments. • A fundus that is above the umbilicus and boggy (feels soft and spongy rather than firm and well contracted) is associated with excessive uterine bleeding. As blood collects and forms clots within the uterus, the fundus rises; firm contractions of the uterus are interrupted, causing a boggy uterus (uterine atony). When the fundus is higher than expected on palpation and is not in the midline (usually deviated to the right), distention of the bladder should be suspected; the bladder should be emptied immediately and the uterus remeasured. • If the woman is unable to void, in-and-out catheterization of the bladder may be required.(straight cath) • After birth the top of the fundus remains at the level of the umbilicus for about half a day. On the first postpartum day, the top of the fundus is located about 1 cm below the umbilicus. The top of the fundus descends approximately one finger breadth(width of index, second, or third finger), or 1 cm, per day until it descends into the pelvis on about the 10th day. Breast feeding hastens this process. • oversized uterus during the pregnancy(because of hydramnios, [LGA] infant, or multiple gestation), the time frame for uterine involution process is lengthened.